| NPI | 1992334528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1002230) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 225531) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 78676) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-04-13 |